That pesky Sarah Palin was right
. . . The administration’s decision to delay implementation of the employer mandate until 2015 will help funnel individuals and families who do not get insurance through their employer into the exchanges. While this may benefit the participating insurers in the short term, this also accelerates the trend toward divorcing health care from employment. This is not a radical idea, and was even proposed by Sen. John McCain in his 2008 presidential campaign. That development will lead to the end of job lock for workers and contribute to a more competitive American business community in the longer run.
That said, the law still has its flaws, and American lawmakers and citizens have both an opportunity and responsibility to fix them.One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.
There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.
The nonpartisan Congressional Budget Office has indicated that the IPAB, in its current form, won’t save a single dime before 2021. As everyone in Washington knows, but less frequently admits, CBO projections of any kind—past five years or so—are really just speculation. I believe the IPAB will never control costs based on the long record of previous attempts in many of the states, including my own state of Vermont.